Can We Talk?

Let's End the Conspiracy of Silence About Ethical Dilemas

by Mary Jo Barrett

It is the end of innocence--the day we enter the land beyond the rulebook. A client wants to give us diamonds. Another invites us to dinner. Another notices that we've stopped wearing a wedding ring, and we wonder how much to tell her. A client moves forward as if to hug us, and then gives us a open-mouthed kiss. Simple dicta no longer seem sufficient.

One way or another, all therapists face similar questions about therapeutic boundaries: Should we accept the gift? How much do we self-disclose? What do we do when a dual relationship can't be avoided? How do we safely negotiate the currents of sexuality? Moved by our best instincts, our weaknesses or simply by the sheer ambiguity of the situation, we can often find ourselvs striking out on our own and coloring outside the lines.

Once upon a time, when psychoanalysis was king, our ethical guidelines were as strict and sacred as the rituals for entering and leaving the Catholic confessional. We spoke the language of transference and countertransference. Both client and therapist knew what to expect: therapy was sacred work, done in a sacred time and space. Within the artificially private walls of the consulting room, human beings felt safe to tell a (usually male) therapist what they dared tell nobody else--relatively confident that they would not later encounter him at daycare or the grocery store. Back then, the dos and don'ts were unambiguous: take no gifts; don't self-disclose; avoid dual relationships; treat all clients equally; create clear boundaries between office and home; steer clear of sexuality.

Today, "therapy" no longer takes place in a book-lined study separate from secular space and time. The walls are porous. Competing models of the therapeutic relationship abound. Are we scientists, shamanic healers, secular ministers, paid friends, skills coaches or purveyors of psychoeducation? Each model contains its own assumptions and morality, and the old consensus on therapeutic ethics and boundaries has broken down. We can agree only on the most egregious forms of boundary violation: when a therapist makes millions as his client's record producer, or sleeps with him or talks about her at a cocktail party, we all know enough to shake our heads.

But once we leave the outrageous violations behind, new realities collide with abstract standards. Where do the "boundaries" lie when therapy can involve in-home visits or the building of a community support group? How do we avoid dual relationships if we practice in a town of less than 2,000 in the Yukon? When is self-disclosure helpful for clients, and when is it an imposition on them or a danger to ourselves?

All of us in clinical practice face these questions, or our own versions of them, almost daily. Yet, as the following stories of our colleagues' encounters with a handful of "sticky situations" show, it's remarkable how few of us talk to anybody about them. Where is our community of peers--that presumed source of sanity inhabiting the space between the ethics board and our solitary face in the bathroom mirror?

By not consulting one another, we have created a culture of avoidance. We use the word "boundary" without any common agreement on what the word means. As a result, we often wing it on our own, fearful of being labeled a boundary violator. We may decide that the situation is special, the client is special or we are special.

We hope that the following pieces--by therapists at every juncture in their careers--will open up a much needed conversation. Below, are accounts of therapists who found themselves unsure of how to deal with four highly chargedÂ areas of ethical ambiguity: self-disclosure, sexuality, gifts and dual relationships. Some of them took chances beyond the rulebook and were happily surprised. Others were not so fortunate. Few consulted with anyone at the time, but all are now sharing their stories with you.

The purpose of these articles is not to come up with a new rulebook. But perhaps these stories can begin to create a therapeutic culture where we openly discuss the moments that we feel our privacy or dignity violated--or that we risk violating those of our clients. Perhaps we can bring our embarrassment and uncertainty into our consultation and supervision groups. There, we might begin to create a consensus wider than our private morality, vulnerability and good intentions.